EEG phase-amplitude coupling to stratify encephalopathy severity in the developing brain

Xinlong Wang; Hanli Liu; Srinivas Kota; Yudhajit Das; Yulun Liu; Rong Zhang; Lina Chalak

doi:10.1016/j.cmpb.2021.106593

EEG phase-amplitude coupling to stratify encephalopathy severity in the developing brain

Comput Methods Programs Biomed. 2022 Feb:214:106593. doi: 10.1016/j.cmpb.2021.106593. Epub 2021 Dec 20.

Authors

Xinlong Wang¹, Hanli Liu¹, Srinivas Kota², Yudhajit Das¹, Yulun Liu³, Rong Zhang⁴, Lina Chalak⁵

Affiliations

¹ Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States.
² Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
³ Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.
⁴ Departments of Internal Medicine and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
⁵ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Lina.chalak@utsouthwestern.edu.

PMID: 34959157
DOI: 10.1016/j.cmpb.2021.106593

Abstract

Background: Neonatal hypoxic ischemic encephalopathy (HIE) is difficult to classify within the narrow therapeutic window of hypothermia. Neurophysiological biomarkers are needed for timely differentiation of encephalopathy severity within the short therapeutic window for initiation of hypothermia therapy.

Methods: A novel analysis of mean Phase Amplitude Coupling index, PAC_m, of amplitudes high frequencies (12-30 Hz) coupled with phases of low (1,2 Hz) frequencies was calculated from the 6 h EEG recorded during the first day of life. PAC_m values were compared to identify differences between mild versus higher-grade HIE, respectively, for each of the EEG electrodes. A receiver operating characteristic curve was generated to examine the performance of PAC_m.

Results: 38 newborns with different HIE grades were enrolled in the first 6 h of life. Threshold PAC_m 0.001 at Fz, O1, O2, P3, and P4 had AUC >0.9 to differentiate HIE severity and predict the persistence of moderate to severe encephalopathy that requires treatment with hypothermia.

Conclusion: PAC is a promising biomarker to identify mild from higher severity of HIE after birth.

Keywords: EEG; Hypoxic ischemia encephalopathy biomarkers; Modified Sarnat Score; Neonatal hypoxic ischemia encephalopathy; Neural oscillation synchrony; Phase amplitude coupling.

MeSH terms

Brain
Electroencephalography
Humans
Hypothermia, Induced*
Hypoxia-Ischemia, Brain* / diagnosis
Hypoxia-Ischemia, Brain* / therapy
Infant, Newborn
ROC Curve